Payment posting that balances the 835 and works the exceptions

Payment posting is the step where a payer remittance is recorded against the claim: the paid amount, the contractual adjustment, the patient responsibility, and the reason for anything not paid. It is the hinge of the revenue cycle. Posted correctly, denials route to appeal and patient balances bill accurately. Posted carelessly, a denial hides inside a zero-pay line and a patient gets billed for a contractual write-off. Most electronic remittance arrives as an 835, but paper EOBs and virtual-card payments still land and have to be reconciled to it. Flexbone posts the 835, reconciles the rest, and works the exceptions.

What is payment posting in medical billing?

Payment posting records what the payer did with a claim. For each service line, the remittance carries the billed amount, the allowed amount, the paid amount, the contractual adjustment, and the patient responsibility, along with a reason for any reduction. Getting this right is what makes the rest of the back end work: a correctly posted denial routes to the denials workflow, a correctly posted patient responsibility flows to the patient statement, and a correctly posted underpayment surfaces for recovery in A/R follow-up. When posting is rushed, those signals get lost, which is why sloppy posting quietly creates denials and patient-billing errors downstream.

How does 835 ERA posting and EOB reconciliation work?

The 835 is the ANSI X12 electronic remittance advice a payer returns for an adjudicated 837 claim, usually paired with an EFT deposit and delivered through a clearinghouse such as Availity or Waystar. Auto-posting reads the 835 and posts each claim, and for clean, fully paid claims it needs no human. The work is the reconciliation and the exceptions: matching the EFT deposit total to the posted 835, reconciling paper EOBs and virtual-card payments that never came as an 835, handling a remittance that splits across multiple checks, and resolving a batch that does not balance. Flexbone posts the 835, reconciles paper EOBs and card payments back to the remittance, and confirms each batch balances to the deposit before it closes.

How are CARC and RARC adjustments and exceptions handled?

Every dollar not paid carries a reason. In the 835 the CAS segment holds one or more Claim Adjustment Reason Codes (CARC), which state why an amount was adjusted, and Remittance Advice Remark Codes (RARC) add detail. Posting has to split these correctly: a CO group code is a contractual write-off, while a PR group code is patient responsibility, and a denial such as CARC 22 or CARC 16 needs to route to rework rather than post silently as paid. Flexbone splits the CAS adjustments into contractual, patient, and denial buckets, posts the write-off, moves the patient balance to statements, and hands denials to the denials workflow with the CARC and RARC attached, so nothing that should be worked disappears into a posted line.

How does Flexbone run payment posting and reconciliation?

Flexbone runs posting as a balanced daily close, not a rushed keystroke job. It posts the 835 from your clearinghouse, reconciles paper EOBs and virtual-card payments back to the remittance, splits CARC and RARC adjustments into contractual, patient, and denial buckets, and confirms each batch ties to the EFT deposit. Denials route to the denials workflow, patient balances flow to statements, and underpayments against the contracted rate are flagged for recovery. Batches that do not balance, or a remark code the rules do not recognize, are held as exceptions for a poster with the detail attached rather than force-posted. The work runs inside your practice management system and is scoped to your payers and clearinghouse.